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Coronary microcirculatory dysfunction is associated with left ventricular dysfunction during follow-up after STEMI.
MedLine Citation:
PMID:  23423600     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Coronary microvascular resistance is increased after primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI), which may be related in part to changed left ventricular (LV) dynamics. Therefore we studied the coronary microcirculation in relation to systolic and diastolic LV function after STEMI.
METHODS: The study cohort consisted of 12 consecutive patients, all treated with primary PCI for a first anterior wall STEMI. At 4 months, we assessed pressure-volume loops. Subsequently, we measured intracoronary pressure and flow velocity and calculated coronary microvascular resistance. Infarct size and LV mass were assessed using magnetic resonance imaging.
RESULTS: Patients with an impaired systolic LV function due to a larger myocardial infarction showed a higher baseline average peak flow velocity (APV) than the other patients (26 ± 7 versus 17 ± 5 cm/s, p = 0.003, respectively), and showed an impaired variable microvascular resistance index (2.1 ± 1.0 versus 4.1 ± 1.3 mmHg cm(-1)∙s(-1), p = 0.003, respectively). Impaired diastolic relaxation time was inversely correlated with hyperaemic APV (r = -0.56, p = 0.003) and positively correlated with hyperaemic microvascular resistance (r = 0.48, p = 0.01). LV dilatation was associated with a reduced variable microvascular resistance index (r = 0.78, p = 0.006).
CONCLUSION: A larger anterior myocardial infarction results in impaired LV performance associated with reduced coronary microvascular resistance variability, in particular due to higher coronary blood flow at baseline in these compromised left ventricles.
Authors:
M Remmelink; K D Sjauw; Z Y Yong; J D E Haeck; M M Vis; K T Koch; J G P Tijssen; R J de Winter; J P S Henriques; J J Piek; J Baan
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation     Volume:  21     ISSN:  1568-5888     ISO Abbreviation:  Neth Heart J     Publication Date:  2013 May 
Date Detail:
Created Date:  2013-04-26     Completed Date:  2013-04-29     Revised Date:  2013-05-02    
Medline Journal Info:
Nlm Unique ID:  101095458     Medline TA:  Neth Heart J     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  238-44     Citation Subset:  -    
Affiliation:
Department of Cardiology, Academic Medical Centre-University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, the Netherlands, m.remmelink@amc.uva.nl.
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